Chapter 8
Mood Disorders
Mood Disorders
 Two key emotions on a continuum:
Depression
Mania
• Depression
• Low, sad state in which life seems dark and
overwhelming
• Mania
• State of breathless euphoria and frenzied energy
Slide 2
Mood Disorders
 Most people with a mood disorder experience only
depression
• This pattern is called unipolar depression
• Person has no history of mania
• Mood returns to normal when depression lifts
 Some people experience periods of depression that
alternate with periods of mania
• This pattern is called bipolar disorder
Slide 3
Mood Disorders
 These disorders have always captured
people’s interest
• Millions of people have mood disorders
• Economic costs of mood disorders amount to
more than $40 billion each year
Slide 4
Unipolar Depression
 The term “depression” is often used to
describe general sadness or unhappiness
• This usage confuses a normal mood swing with a
clinical syndrome
 Clinical depression can bring severe and long-
lasting psychological pain that may intensify
over time
Slide 5
How Common Is Unipolar
Depression?
 5 to 10% of the U.S. population experiences
severe unipolar depression each year
• An additional 3 to 5% experience mild depression
 ~17% of the world population experiences
unipolar depression at some time in their lives
• Rates have been steadily increasing since 1915
Slide 6
How Common Is Unipolar
Depression?
 In almost all countries, women are twice as likely as
men to experience severe unipolar depression
• Lifetime prevalence: 26% of women vs. 12% of men
 These rates hold true across socioeconomic classes
and ethnic groups
 ~50% recover within six weeks, some without
treatment
• Most will experience another episode at some point
Slide 7
What Are the Symptoms of
Depression?
 Symptoms may differ dramatically from person to
person
 Five main areas of functioning may be affected:
• Emotional symptoms
• feeling “miserable,” “empty,” “humiliated”
• Motivational symptoms
• lack drive, initiative, spontaneity
• 6 to 15% of those with severe depression commit suicide
Slide 8
What Are the Symptoms of Unipolar
Depression?
 Five main areas of functioning may be
affected:
• Behavioral symptoms
• less active, less productive
• Cognitive symptoms
• hold negative opinion of themselves
• blame themselves for unfortunate events
• Physical symptoms
• headaches, dizzy spells, general pain
Slide 9
Diagnosing Unipolar Depression
 Criteria 1: Major depressive episode
• Marked by five or more symptoms lasting two or
more weeks
• In extreme cases, symptoms are psychotic, including
• Hallucinations
• Delusions
 Criteria 2: No history of mania
Slide 10
Diagnosing Unipolar Depression
 Two diagnoses to consider:
• Major depressive disorder
• Criteria 1 and 2 are met
• Dysthymic disorder
• Symptoms are “mild but chronic”
• Experience longer-lasting but less disabling depression
• Consistent symptoms for at least two years
• When dysthymic disorder leads to major depressive
disorder, the sequence is called “double depression”
Slide 11
What Causes Unipolar Depression?
 Stress may be a trigger for depression
• People with depression experience a greater
number of stressful life events during the month
just prior to the onset of their symptoms
• Some clinicians distinguish reactive (exogenous)
depression from endogenous depression, which
seems to be a response to internal factors
• The utility of this distinction is questionable
Slide 12
What Causes Unipolar Depression?
The Biological View
 Genetic factors
• Family pedigree, twin, and adoption studies suggest that
some people inherit a biological predisposition
• Relatives of those with depression have higher rates of depression
compared with members of the general population
• Twin studies demonstrate a strong genetic component:
• Rates for identical (MZ) twins = 46%
• Rates for fraternal (DZ) twins = 20%
• Adoption studies have also implicated a genetic factor in cases of
severe unipolar depression
Slide 13
What Causes Unipolar Depression?
The Biological View
 Biochemical factors
• NTs: serotonin and norepinephrine
• In the 1950s, medications for high blood pressure were
found to increase depression
• Some lowered serotonin, others lowered norepinephrine
• Led to “discovery” of effective antidepressant medications
• It is likely not just one NT or the other – a complex
interaction is at work
Slide 14
What Causes Unipolar Depression?
The Psychological Views
 Three main models:
• Psychodynamic model
• Not strongly supported by research
• Behavioral model
• Modestly supported by research
• Cognitive model
• Has considerable research support
Slide 15
What Causes Unipolar Depression?
The Psychological Views
 Cognitive views
• Two main theories:
• Negative thinking
• Learned helplessness
Slide 16
What Causes Unipolar Depression?
The Psychological Views
 Cognitive views
•
Negative thinking
•
Beck theorizes four interrelated cognitive
components of depression:
1. Maladaptive attitudes
•
Self-defeating attitudes are developed during childhood
•
Beck suggests that upsetting situations later in life can
trigger further rounds of negative thinking
Slide 17
What Causes Unipolar Depression?
The Psychological Views
 Cognitive views
•
Negative thinking often takes three forms
1. This is called the cognitive triad:
•
Individuals repeatedly interpret (1) their experiences, (2)
themselves, and (3) their futures in negative ways, leading
to depression
Slide 18
What Causes Unipolar Depression?
The Psychological Views
 Cognitive views
• Strengths:
• There is significant research support for Beck’s model:
• High correlation between the level of depression and the
number of maladaptive attitudes held
• Both the cognitive triad and errors in logic are seen in people
with depression
• Automatic thinking has been linked to depression
• Limitations:
• Research fails to show that such cognitive patterns are the cause
and core of unipolar depression
Slide 19
What Causes Unipolar Depression?
The Psychological Views
 Cognitive views
• Learned helplessness
• Theory is based on Seligman’s work with laboratory
dogs
• Dogs subjected to uncontrollable shock were later placed in a
shuttle box
• Even when presented with an opportunity to escape, dogs that
had experienced uncontrollable shocks made no attempt to do
so
• Seligman theorized that the dogs had “learned” to be
“helpless” and drew parallels to human depression
Slide 20
What Causes Unipolar Depression?
The Sociocultural View
 How do gender and race relate to depression?
• Rates of depression are much higher among women than men
• One sociocultural theory holds that the complexity of women’s
roles in society leaves them particularly prone to depression (see
Box 8-4)
• Few differences have been seen among Caucasians, African
Americans, and Hispanic Americans, but striking differences exist in
specific subcultures:
• In a study of one Native American village, lifetime risk was 37%
among women, 19% among men, and 28% overall
• These findings are thought to be the result of economic and social
pressures
Slide 21
Bipolar Disorders
 People with a bipolar disorder experience
both the lows of depression and the highs of
mania
• They describe their life as an emotional roller
coaster
Slide 22
What Are the Symptoms of Mania?
 Five main areas of functioning may be affected:
• Behavioral symptoms
• very active – move quickly; talk loudly or rapidly
• Key word: flamboyance!
• Cognitive symptoms
• show poor judgement or planning
• Especially prone to poor (or no) planning
• Physical symptoms
• high energy level – often in the presence of little or no rest
Slide 23
Diagnosing Bipolar Disorders
 Two kinds of bipolar disorder:
• Bipolar I disorder
• Full manic and major depressive episodes
• Most sufferers experience an alternation of
episodes
• Some experience mixed episodes
• Bipolar II disorder
• Hypomanic episodes and major depressive episodes
Slide 24
Diagnosing Bipolar Disorders
 Between 1 and 1.5% of adults in the world
suffer from a bipolar disorder at any given
time
 The disorders are equally common in women
and men
• Women may experience more depressive and
fewer manic episodes than men
• Rapid cycling is more common in women
Slide 25
What Causes Bipolar Disorders?
 Neurotransmitters (NTs)
• This apparent contradiction is addressed by the
“permissive theory” about mood disorders:
• Low serotonin may “open the door” to a mood
disorder and permit norepinephrine activity to define
the particular form the disorder will take:
• Low serotonin + Low norepinephrine = Depression
• Low serotonin + High norepinephrine = Mania
Slide 26
What Causes Bipolar Disorders?
 Genetic factors
• Many experts believe that people inherit a biological predisposition to
develop bipolar disorders
• Findings from family pedigree studies support this theory; when one twin
or sibling has bipolar disorder, the likelihood for the other twin or sibling
increases:
• Identical (MZ) twins = 40% likelihood
• Fraternal (DZ) twins and siblings = 5 to 10% likelihood
• General population = 1% likelihood
• Recently, genetic linkage studies have examined the possibility of
“faulty” genes
• Other researchers are using techniques from molecular biology to
further examine genetic patterns
Slide 27